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DayOne - Next generation Clinical Trials
Stijn Rogiers, Principal Industry Consultant
SAS Global Health and Life Sciences Practice
June 25th 2019
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
Twitter: @StijnRogiers
LinkedIn: https://www.linkedin.com/in/stijnrogiers/
Email: stijn.rogiers@sas.com
Introduction
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
Real World Evidence
“Maximize product value beyond efficacy and safety”
Society
Patient
Provider
Clinical
Economic
Payer/HTA
Comparative
effectiveness
Cost-utility
Budget Impact
Long-term
Outcomes
Direct/Indirect Cost
Cost:Outcomes
Cost Consequences
Resource Utilization
QALY
Equal access to healthcare
Return to work
Caregiver burden
Productivity
Morbidity, Mortality
Symptoms
Functionality
Preferences
Quality of Life
Effectiveness
Tolerability
Safety
Compliance
Adherence
ConvenienceEfficacy
Safety
Morbidity
Mortality
Case Study: Maximize Product Value with Real World Evidence, Maria Kubin, VP Bayer Healthcare –Eye for Pharma
Copyright © SAS Institute Inc. All rights reserved.
Regulatory Perspective (US FDA)
Framework for FDA's Real World Evidence Program (Dec 2018)
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
Company Confidential – For Internal Use Only
Copyright © SAS Institute Inc. All rights reserved.
PRO
EMR
CLAIMS
LABS
RX
REGISTRY
COA
SAFETY
MORTALITY
DIGITAL
mHEALTH
SOCIAL MEDIA
CONSUMER
Patient
Recruitment
Trial
Optimization
Synthetic
Control Arms
BOI
Drug
Utilization
PASS
Pragmatic
Trial
Natural
Hx
Risk /
Benefit
Disease
Mechanism
Comorbidities
Value
Prop
Patient
Journey
Economic
Model
Comparative
Effectiveness
Outcome
Predictions
Patient
Journey
Epidemiology
Pharmacovigilance
Regulatory
Affairs
R&D
Medical Affairs
HEOR
Market Access
HTA
Commercial
Copyright © SAS Institute Inc. All rights reserved.
Feasibility Analysis
How can sponsors accurately measure the feasibility of a protocol and plan accordingly to
achieve timely and cost-effective enrollment and the quality data to advance their pipelines?
 True clinical trial feasibility includes strategic, scientific, operational, and patient recruitment considerations
 Traditional approach in our industry
 Historical Data / Past Experiences, Previous Studies (CRO, Pharma)
 Discussions with potential sites and Patient Organizations
 Educated guesses
 Focus is on the enrollability of a clinical trial
Copyright © SAS Institute Inc. All rights reserved.
Cohort Generation
“What if scenario(s)” … What if we loosen exclusion criteria
https://www.statnews.com/2018/04/05/clinical-trials-excluding-patients/
Running clinical trials effectively and efficiently is critical to medical progress, not
just in cancer care but across disciplines. Allowing more patients to be enrolled in
trials will speed the medical innovation process, allow more sick people to access
potentially beneficial therapies, and produce more generalized results. Spurred by
this month’s FDA meeting, lead researchers, sponsors, and regulators must rethink
their approach to clinical trial eligibility (5 Apr 2018).
Copyright © SAS Institute Inc. All rights reserved.
Add-ins
Cohort Characterization Reports
Copyright © SAS Institute Inc. All rights reserved.
Add-ins
Use SAS (industry) / Develop company specifics
Copyright © SAS Institute Inc. All rights reserved.
Clinical Trial Operational Analytics
Enrollment Optimization: State / Site Selection
State
CA
Fl
IL
MI
NY
Copyright © SAS Institute Inc. All rights reserved.
Clinical Trial Operational Analytics
Enrollment Optimization: Stringent Vs. Relaxed
Stringent Scenario
Relaxed Scenario
Copyright © SAS Institute Inc. All rights reserved.
Generate additional insights
Data Mining & Machine Learning – Model Comparison
Copyright © SAS Institute Inc. All rights reserved.
A Study showing real world use of ‘real world data’
http://theoncologist.alphamedpress.org/content/early/2018/12/27/theoncologist.2018-
0307.short?rss=1&related-urls=yes&legid=theoncologist;theoncologist.2018-0307v1
https://datavant.com/2019/01/14/a-study-showing-real-world-use-of-real-world-data/
Copyright © SAS Institute Inc. All rights reserved.
AI and medicine
Copyright © SAS Institute Inc. All rights reserved.
Results
An in-depth scan
has a lot of data and the
outcomes can be
improved with the use of
advanced analytics on
patients’ health data and
history.
“
”Prof. Dr. Geert Kazemier
Cancer Center Amsterdam, aUMC
Automatic Segmentation
Copyright © SAS Institute Inc. All rights reserved.
Precision medicineAI and medicine
Kim et al., Nature Biotechnology, 37, 389-406 (2019)
Copyright © SAS Institute Inc. All rights reserved.
ASSIST’s Always-on Wearable Platforms
Long Term Monitoring of health and environment
Correlation of multiple sensors signals
Clinical studies in various health domains
• Self-powered
• Physiological, biochemical
and environmental sensors
• Wearable, wireless and
comfortable
• Informative and continuous
data
25
Copyright © SAS Institute Inc. All rights reserved.
Pricing and cost Ethical rulesAI/ML regulation Data TransparencyPersonal data
protection
Copyright © SAS Institute Inc. All rights reserved.
AI IN Health Care and Life Sciences
OPERATIONAL
EFFICIENCY
CLINICAL SCIENCE
 Reducing physician burnout
 Meaningfully connect different data sources
 Financial impact, cost, fraud and abuse
 Workflow optimization (simulation, DL)
 Clinical trial operations
 Manufacturing quality
REGULATION AND
GOVERNANCE
Efficiency increase of health
care and clinical development
Faster access to care and
support for physician
Risk, governance, auditability
 Deep learning for computer vision and
biological signals
 IoMT : wearables, devices and modern
clinical trials
 Patient engagement : chatbots
 RWE – cohort analysis – matching
patients,
 Ethical AI
 Enterprise implementation and
repeatability
 Data privacy
 Traceability

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Next Generation Digital Trials - Introduction to a changing landscape

  • 1. Copyright © SAS Institute Inc. All rights reserved. 1 DayOne - Next generation Clinical Trials Stijn Rogiers, Principal Industry Consultant SAS Global Health and Life Sciences Practice June 25th 2019
  • 2. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved. Twitter: @StijnRogiers LinkedIn: https://www.linkedin.com/in/stijnrogiers/ Email: stijn.rogiers@sas.com Introduction
  • 3. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved. Real World Evidence “Maximize product value beyond efficacy and safety” Society Patient Provider Clinical Economic Payer/HTA Comparative effectiveness Cost-utility Budget Impact Long-term Outcomes Direct/Indirect Cost Cost:Outcomes Cost Consequences Resource Utilization QALY Equal access to healthcare Return to work Caregiver burden Productivity Morbidity, Mortality Symptoms Functionality Preferences Quality of Life Effectiveness Tolerability Safety Compliance Adherence ConvenienceEfficacy Safety Morbidity Mortality Case Study: Maximize Product Value with Real World Evidence, Maria Kubin, VP Bayer Healthcare –Eye for Pharma
  • 4. Copyright © SAS Institute Inc. All rights reserved. Regulatory Perspective (US FDA) Framework for FDA's Real World Evidence Program (Dec 2018)
  • 5. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved.
  • 6. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved.
  • 7. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved.
  • 8. Company Confidential – For Internal Use Only Copyright © SAS Institute Inc. All rights reserved. PRO EMR CLAIMS LABS RX REGISTRY COA SAFETY MORTALITY DIGITAL mHEALTH SOCIAL MEDIA CONSUMER Patient Recruitment Trial Optimization Synthetic Control Arms BOI Drug Utilization PASS Pragmatic Trial Natural Hx Risk / Benefit Disease Mechanism Comorbidities Value Prop Patient Journey Economic Model Comparative Effectiveness Outcome Predictions Patient Journey Epidemiology Pharmacovigilance Regulatory Affairs R&D Medical Affairs HEOR Market Access HTA Commercial
  • 9. Copyright © SAS Institute Inc. All rights reserved. Feasibility Analysis How can sponsors accurately measure the feasibility of a protocol and plan accordingly to achieve timely and cost-effective enrollment and the quality data to advance their pipelines?  True clinical trial feasibility includes strategic, scientific, operational, and patient recruitment considerations  Traditional approach in our industry  Historical Data / Past Experiences, Previous Studies (CRO, Pharma)  Discussions with potential sites and Patient Organizations  Educated guesses  Focus is on the enrollability of a clinical trial
  • 10. Copyright © SAS Institute Inc. All rights reserved. Cohort Generation “What if scenario(s)” … What if we loosen exclusion criteria https://www.statnews.com/2018/04/05/clinical-trials-excluding-patients/ Running clinical trials effectively and efficiently is critical to medical progress, not just in cancer care but across disciplines. Allowing more patients to be enrolled in trials will speed the medical innovation process, allow more sick people to access potentially beneficial therapies, and produce more generalized results. Spurred by this month’s FDA meeting, lead researchers, sponsors, and regulators must rethink their approach to clinical trial eligibility (5 Apr 2018).
  • 11. Copyright © SAS Institute Inc. All rights reserved. Add-ins Cohort Characterization Reports
  • 12. Copyright © SAS Institute Inc. All rights reserved. Add-ins Use SAS (industry) / Develop company specifics
  • 13. Copyright © SAS Institute Inc. All rights reserved. Clinical Trial Operational Analytics Enrollment Optimization: State / Site Selection State CA Fl IL MI NY
  • 14. Copyright © SAS Institute Inc. All rights reserved. Clinical Trial Operational Analytics Enrollment Optimization: Stringent Vs. Relaxed Stringent Scenario Relaxed Scenario
  • 15. Copyright © SAS Institute Inc. All rights reserved. Generate additional insights Data Mining & Machine Learning – Model Comparison
  • 16. Copyright © SAS Institute Inc. All rights reserved. A Study showing real world use of ‘real world data’ http://theoncologist.alphamedpress.org/content/early/2018/12/27/theoncologist.2018- 0307.short?rss=1&related-urls=yes&legid=theoncologist;theoncologist.2018-0307v1 https://datavant.com/2019/01/14/a-study-showing-real-world-use-of-real-world-data/
  • 17. Copyright © SAS Institute Inc. All rights reserved. AI and medicine
  • 18. Copyright © SAS Institute Inc. All rights reserved. Results An in-depth scan has a lot of data and the outcomes can be improved with the use of advanced analytics on patients’ health data and history. “ ”Prof. Dr. Geert Kazemier Cancer Center Amsterdam, aUMC
  • 20. Copyright © SAS Institute Inc. All rights reserved. Precision medicineAI and medicine Kim et al., Nature Biotechnology, 37, 389-406 (2019)
  • 21. Copyright © SAS Institute Inc. All rights reserved. ASSIST’s Always-on Wearable Platforms Long Term Monitoring of health and environment Correlation of multiple sensors signals Clinical studies in various health domains • Self-powered • Physiological, biochemical and environmental sensors • Wearable, wireless and comfortable • Informative and continuous data 25
  • 22. Copyright © SAS Institute Inc. All rights reserved. Pricing and cost Ethical rulesAI/ML regulation Data TransparencyPersonal data protection
  • 23. Copyright © SAS Institute Inc. All rights reserved. AI IN Health Care and Life Sciences OPERATIONAL EFFICIENCY CLINICAL SCIENCE  Reducing physician burnout  Meaningfully connect different data sources  Financial impact, cost, fraud and abuse  Workflow optimization (simulation, DL)  Clinical trial operations  Manufacturing quality REGULATION AND GOVERNANCE Efficiency increase of health care and clinical development Faster access to care and support for physician Risk, governance, auditability  Deep learning for computer vision and biological signals  IoMT : wearables, devices and modern clinical trials  Patient engagement : chatbots  RWE – cohort analysis – matching patients,  Ethical AI  Enterprise implementation and repeatability  Data privacy  Traceability